Value of magnetic resonance cholangiopancreatcography in demonstrating major bile duct injuries following laparoscopic cholecystectomy

Background: Conventionally, recognition of bile duct injuries after laparos copic cholecystectomy largely relies on endoscopic retrograde cholangiopanc reatography (ERCP) and percutaneous transhepatic cholangiography (PTC). How ever, these invasive procedures are not without risk. Preliminary experienc e with use of magnetic resonance cholangiopancreatography (MRCP) to identif y these injuries is reported. Methods: The medical records of five patients who had undergone laparoscopi c cholecystectomy and had suspected major bile duct injuries were reviewed. All five patients underwent MRCP, followed by conventional cholangiography : either ERCP or PTC, or both. The findings of MRCP and conventional cholan giography were compared. Results: Four patients had proven bile duct injuries. The remaining patient had gallstones dislodged into the common bile duct (CBD) during laparoscop ic cholecystectomy, which presented as transient jaundice mimicking a bile duct injury. The MRCP images were of higher diagnostic value than conventio nal cholangiographic images in four patients with frank bile duct injury. F or these patients, ERCP showed only the cut-off sign of the CBD, and PTC wa s needed to visualize the upper biliary system. MRCP, however, demonstrated the entire biliary system proximal and distal to the amputated or stenotic sites simultaneously. In the remaining patient with dislodged gallstones, the two techniques yielded similar diagnostic information. Conclusion: This preliminary study suggests that MRCP is an ideal diagnosti c test whenever bile duct injury following laparoscopic cholecystectomy is suspected.